2006 Ft Knox Army Family Action Plan Conference Delegate Registration Form
January 24-26, 2006

Click here to return to AFAP Event Page

First Name:
Last Name:


Phone Number:



Grade or rank of delegate:

Rank of military sponsor/spouse:

How would you like your name printed on your nametag:

Delegate Status: Check all that apply.
  female male
  spouse of civilian employee spouse of retired military
  soldier retired military
  family member Single Parent
  teen   single soldier
  single   spouse of active reserve
  married   active reserve
  civilian employee spouse of reserve military
  spouse of active duty military reserve military
  dual military  
   active duty military

Workgroup Preference: Rank preferences 1, 2, 3       Type number in the box provided.
(preferences are not guaranteed)

  Consumer Services          
  Family Supprt                Medical Services      
  Housing/Relocation         Teen Discovery          
  Youth and Education               

Will you require childcare? 

  Yes      No  
  If yes, what ages?  
  CDC will provide childcare. You must make your own reservation by calling 502-624-8300. Deadline for making reservations is January 6. Childcare vouchers will be provided at the symposium.

After submitting this form, please return to AFAP Event Page to obtain child care request forms.


Have you ever participated in an AFAP Conference? Is so when and where?


  Any questions regarding this registration should be referred to the AFAP office at 502-624-6291/8300.
  DATA REQUIRED BY THE PRIVACY ACT OF 1974: AUTHORITY: 5 USC 301, 10 USC 3013, and EO 9397 (SSN).  PRINCIPLE PURPOSE: Identification of participants in the Army Family Action Plan Symposium.  ROUTINE USES: To record the names and addresses of attendees at the Army Family Action Plan Symposium.  DISCLOSURE:  Disclosure is voluntary.  If not provided, registration for the symposium may not be possible.